Osteolytic tumor

Osteolytic tumors may induce bone destruction either through local invasion, or by a secondary metastatic bone disease. The most frequent types of primary tumors that develop into metastatic bone disease are, in the order of prevalence breast, prostate, thyroid, kidney, and bronchial tumors, whereas esophageal, gastrointestinal and rectal tumors are much less metastatic [11]. Very often, the destruction of bone in a metastatic bone disease leads to hypercalcemia of malignancy, which also responds to BPs. In addition, hematological cancers such as... 

Especially in the mandible, the spongiosa pattern in older patients can be reduced regionally and can mimic an osteolytic tumor in panoramic views. The mandibular canal may no longer be identified. By CT, the ratification of the spongiosa can be clarified as a systemic process relatively easily and differentiated from neoplasm. 

It has been reported that cement leakage is more common when PV is used for metastatic osteolytic tumors or myelomas of the spine than in osteoporotic fractures. However, Vasconcelos et al. (2002) observed no major differences, although they noted venous leaks slightly more frequently in patients with metastatic lesions. When PV was performed in osteoporotic vertebral compression fractures, leakage into the disc space was more commonly observed. Mousavi et al. (2003) reviewed post-procedural GT scans in patients with osteoporotic vertebral compression fractures and metastatic lesions of the spine and concluded that in osteoporotic vertebrae leakage occurred mainly into the disc, whereas in metastatic lesions it was found in various different locations. 

The delicate balance maintained by these factors is altered in patients with cancer by two principal mechanisms tumor production of humoral factors that alter calcium metabolism (humoral hypercalcemia) and local osteolytic activity from bone metastases.27 Humoral hypercalcemia causes around 80% of all hypercalcemia cases and is mediated primarily by systemic secretion of parathyroid hormone-related protein... 

Meanwhile, some phase 2 trials have already been performed on some naturally cancerous dogs, bearing tumors which are histologically close to the corresponding human ones, namely, osteolytic osteosarcomas and fibrosarcomas (bone cancers). Let us give some details about the protocol of treatment we used in the case of a dog weighing 70 kg and suffering from an acute osteolytic osteosarcoma (expected survival time less than 2 weeks on March 26, 1981). 

E. Therapeutic response In prostate cancer, a complete response is considered to be disappearance of tumor masses, normalization of elevated acid phosphatase, disappearance of osteoblastic lesions, recal-cihcation of osteolytic lesions, and normalization of hepatomegaly and abnormal... 

Osteolytic bone diseases or bone resorption the most important clinical application of BPs is as inhibitors of osteolytic bone diseases, including osteoporosis, tumor-related bone destruction, and Paget s disease. These are discussed in detail in the next section. 

IgD (1.5% myelomatosis) paraproteins are harder to find and usually are associated with heavy Bence Jones (90%L) proteinuria. Severe immune paresis and infection are not so common, but hypercalcemia (47%), osteolytic lesions (77%), extraosseous tumor (63%), and renal failure (52%) are common, as is presentation under 50 years of age (H36). 

Metastatic spread can occnr by local extension, lymphatic drainage, or hematogenous dissemination. Lymph node metastases are more common in patients with large, nndifferentiated tumors that invade the seminal vesicles. The pelvic and abdominal lymph node gronps are the most common sites of lymph node involvement (Fig. 128-1). Skeletal metastases from hematogenous spread are the most common sites of distant spread. Typically, the bone lesions are osteoblastic or a combination of osteoblastic and osteolytic. The most common site of bone involvement is the lumbar spine. Other sites of bone involvement include the proximal femurs, pelvis, thoracic spine,... 

The humoral hypercalcemia of malignancy hypothesis states that an osteolytic non-PTH substance is secreted by certain tumors and, in an endocrine manner, is transported from tumor to bone through the bloodstream. The evidence for this hypothesis is that 1) bone destruction occurs in patients without bone metastases, 2) serum PTH levels in these patients were usually normal, 3) PTH mRNA was absent in tumors (27), and 4) tumor extracts from hypercalcemic patients enhanced bone cell adenylate cyclase activity and phosphate transport in kidney epithelial cells (28-30). 

Fig. 3 (A) Bioluminescent image of nude mouse 4 weeks after intratibial inoculation of osteosarcoma cells carrying a luciferase reporter gene. (B) Radiograph taken at 4 weeks shows the formation of osteolytic lesions in the corresponding region. Tc]MIBI images acquired at early (5 min) and delayed times (60 min) in the absence (C) and after treatment with PSC833 (D). The treatment with 50 mg/kg PSC833 increased both the uptake and the retention of [ Tc]MIBI in the tumor region...

Recurrent cervical cancer is associated with bone metastases (Fig. 7.39) in 15%-29% of patients at autopsy [ too, 103]. Typical locations are the bony pelvis as well as the lumbar and other vertebral bodies. Bone metastases in the ribs and extremities are less common. Skeletal metastases typically have an osteolytic character and originate from locally advanced or recurrent tumor in the pelvic sidewall or arise through retrograde tumor spread in patients with para-aor-tic lymph node metastasis [104]. Hematogenous dissemination to the skeleton occurs late. MRl with unenhanced and contrast-enhanced fat-saturated Tl-weighted sequences depicts bone metastases as hyperintense lesions in the low-intensity bone marrow with a high sensitivity. CT primarily shows the extent of osseous destruction. 

RF ablation has been used as an alternative method for treating certain bone tumors such as painful osteolytic metastatic lesions (Callstrom et al. 2000), osteoid osteoma (Rosenthal et al. 1992,1995,2001), and chondroblastoma (Erickson et al. 2001). 

In cancer patients, PC is used particularly in the symptomatic treatment of osteolytic bone metastasis and myeloma. As PC is only aimed at treating pain and consolidating weight-bearing bone, other specific tumor therapy should be carried out in conjunction for tumor management when appropriate. 

To date, the mechanical properties of the metastatic spine and the mechanisms of collapse have not been fuUy elucidated. Moreover, the correlation between vertebral body coUapse and the location and extent of the metastatic tumor is not fully understood. Taneichi et al. (1997) evaluated 100 thoracic and lumbar vertebrae (53 patients) with osteolytic lesions, determined risk factors for vertebral coUapse, and estimated the probability of coUapse under various states of metastatic vertebral involvement. The most important risk factor leading to vertebral coUapse in the thoracic region was involvement of the costovertebral joint. Tumor size within the vertebral body was the second most important risk factor. In-... 

Fig. 38.7a-f. A 71-year-old male patient suffering from a painful and destabilizing osteolytic renal cell cancer metastasis of the 5th lumbar vertebra (a, d). In order to avoid radiculopathy as a result of cement contact with the adjacent nerve root and heating of the nerve tissue during tumor ablation (c, long arrow - RFA electrode within the metastasis) and the polymer-... 

Especially in palliative situations, radiofrequency ablation has successfully been applied to osteolytic me-tastases and soft tissue tumors involving the bone to relieve pain (Goetz et al. 2004) or as an adjunct to vertebra- or osteoplasty. Furthermore, RFA has also been used for tumor debulking if the tumor causes pressure symptoms such as dysphagia or dyspnea. 

Jang JS, Lee SH (2005) Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors. J Neurosurg Spine 2(3) 243-248 Kelekis A, Lovblad KO, Mehdizade A et al (2005) Pelvic osteoplasty in osteolytic metastases technical approach under fluoroscopic guidance and early clinical results. J Vase Interv Radiol 16(l) 81-88 Klein MH, Shankman S (1992) Osteoid osteoma radiologic and pathologic correlation. Skeletal Radiol 21(1) 23-31... 

Traumatic lesions, fractures, osteolytic erosion of tumorous and inflammatory origin are readily detectable on tomograms. In inflammatory processes there may be an increased width of the retropharyngeal soft-tissue space on lateral view. 

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